Dr. Mary Claire Haver on Menopause: Recorded Live from LA with Dr. Rena Malik

**Mary Claire Haver** (0:00)
Today's episode is a little different. This conversation was originally recorded live at the Wiltern Theater in Los Angeles, in front of an audience of women who came ready to talk about perimenopause, menopause, hormones, sex, brain health, bone health, and all the things we still don't talk about nearly enough. I was joined on stage by my friend, Dr. Rena Malik, a board-certified urologist, pelvic medicine specialist, and sexual health expert, who has become one of the most trusted voices in this space. Rena and I had a wide-ranging conversation about what is actually happening to women's bodies during the menopause transition, and why so many of us, including physicians, were never really taught to understand it. We went deep into the zone of chaos that is perimenopause, the changes in mood, sleep, cognition, metabolism, and inflammation. What women should know about hormone therapy and the legacy of the Women's Health Initiative, and why protecting your bones needs to start much earlier than most of us realize. We also talked candidly about sex, pain, desire, vaginal estrogen, testosterone, and how to advocate for yourself when your symptoms are dismissed or you're told everything is normal.
And because we had a theater full of women, we got to hear from them too. We answered audience questions about everything from hot flashes in libido to GLP-1s, heart palpitations, and how to separate good menopause information from whatever somebody is trying to sell you on social media.
But the message I hope you take away from this conversation is one that we ended with that night. Perimenopause is inevitable. Suffering is not.
We have tools, we have information, we have a community, and the more openly we talk about this, the better it gets for every woman coming behind us. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner and adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to unPAUSED, where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

**Rena Malik** (2:33)
Hey, everybody. Who's excited? I'm Dr. Rena Malik. I'm truly honored to host today Dr. Mary Claire Haver. She is a dear friend of mine, and as you all know, she has done more for advancing women's health in midlife than anyone I know. So let's give it up for the most amazing human, wonderful person, Girls Girl, Dr. Mary Claire Haver.
All right. So as you guys all know, The New Perimenopause is a New York Times bestseller.
So let's start off. What inspired you to write The New Perimenopause? Why was this the right time?

**Mary Claire Haver** (3:32)
Because when you look at the happiness curve for women, it's a U-shape, and the nadir is at 47 years old.
That is your most unhappy. The most likely time for and trigger warning for a woman to commit suicide is between the ages of 45 and 55
When we look at women leaving their jobs, and when you look at the peak career level for women, it's at 47 And I'm like, can we connect the dots here hormonally and see what's going on? I was also bombarded on social media, thank you guys, with women who had read menopause and said, hey, I'm not quite there yet. What about me? I learned more about rare infectious diseases in medical school than I did about menopause.

**Rena Malik** (4:27)
Me too.

**Mary Claire Haver** (4:28)
You know, I know more about scurvy than perimenopause. We never said the word perimenopause in medical school, and in my residency, I knew how to pronounce it and that it was just a transition into menopause, but we had no perimenopause clinics. There's never been a single long-term study in the treatment of perimenopause.
And women are suffering, they're getting blindsided. And I thought, I'm going to do the best I can with the data we have and put something together so that women don't suffer unnecessarily and you have tools to help manage this.

**Rena Malik** (5:05)
Yeah.
And the reality is there's not a lot of data. There's very few studies on perimenopause.

**Mary Claire Haver** (5:14)
So if I look at, so let's kind of look at women's health overall. And if we look at the NIH budget in 2023, now things are changing rapidly, so I'm going to go back to some older data. The majority of that funding went to pregnancy, important stuff, happy to have it, right? And to breast and ovarian cancer. Almost nothing for menopause, which affects 51 percent of the population.
Almost nothing for endometriosis, almost nothing for fibroids, almost nothing for PCOS, okay? But if I go right now to PubMed today and I type in the word, PubMed is where we go look up medical research articles, you know, the really high quality stuff. And I type in the word pregnancy, we get 1.2 million articles, so important. I am a great obstetrician, right? I know so much about pregnancy, getting people pregnant, keeping them pregnant, making them un-pregnant when they need to be in postpartum care. If I type in the word menopause, we have 104,000 articles, so it's like 12 to 1, pregnancy versus menopause. But if I type in the word perimenopause, it's 7,000.